Examination of the Knee

Expect These Tests When You Have Knee Pain

knee examination
Doctor examining female patient's leg. UpperCut Images

Determining the cause of knee pain relies on a proper examination of the knee joint. You may wonder what your doctor is looking for as he moves and pushes on your knee during an examination. Learn about how your doctor can examine your knee to determine the source of your pain, and what tests can be performed to make the diagnosis.

Tests to Detect Knee Swelling

Many people know if their knee is swollen -- they can see or feel the swelling without any difficulty.

However, not everyone knows there is excess fluid in the knee joint. Your doctor may compress the joint to feel for excess fluid. Fluid often collects above the kneecap, and can be compressed in this area. Fluid is also often detected in the back of the knee, a problem people often refer to as a Baker's cyst.

Tests to Detect Knee Arthritis

Knee arthritis can be detected by looking for several characteristic examination findings:

  • Crepitus: Crepitus is the sensation that is felt when rough cartilage or exposed bone is rubbing as the knee is bent. The examiner will feel, and may hear, this grinding as the knee is bent back and forth.
  • Deformity: As the knee cartilage is worn away, the knees may become progressively knock-kneed or bow-legged.
  • Limited Motion: The range of motion of the knee typically becomes limited if arthritis, bone spurs, and swelling prevents normal mobility.

Tests to Detect a Torn Meniscus

Tests used to determine if there is a meniscus tear include:

  • Joint Line Tenderness: Joint line tenderness is a very non-specific test for a meniscus tear. The area of the meniscus is felt, and a positive test is considered when there is pain in this area.
  • McMurray's TestMcMurray's test is performed with the patient lying flat on his back and the examiner bending the knee. A click is felt over the meniscus tear as the knee is brought from full flexion to full extension.
  • Ege's Test: Ege's test is performed with the patient squatting, a click is heard/felt over the area of the meniscus tear.

Tests to Detect an ACL Tear

  • Lachman Test: The Lachman test is the best test to diagnose an ACL tear. With the knee slightly bent, the examiner stabilizes the thigh while pulling the shin forward. A torn ACL allows the shin to shift too far forward.
  • Anterior Drawer Test: This test is also performed with the patient lying flat on his back. The knee is bent 90 degrees and the shin is pulled forward to check the stability of the ACL.
  • Pivot Shift Test: The pivot shift test is a difficult maneuver to perform on a patient who is not under anesthesia. This test places a stress on the knee joint that forces a partial dislocation in patients with a damaged ACL.

Tests to Detect Other Ligament Injuries

  • Posterior Drawer Test: The posterior drawer is performed similarly to the anterior drawer test. This test detects injury to the PCL. By pushing the shin backward, the function of the PCL is tested.
  • Collateral Ligament Stability: Side-to-side stability of the knee detects problems of the collateral ligaments, the MCL and LCL. With the patient lying flat, and the knee held slightly bent, the shin is shifted to each side. Damage to the LCL or MCL will allow the knee to "open up" excessively, a problem called varus (LCL) or valgus (MCL) instability.

Tests to Detect Kneecap Problems:

  • Patellar Grind: The patient lies supine with the leg extended. The examiner reproduces the patient's knee pain by pushing the kneecap down and asking the patient to flex his thigh muscles. Damaged cartilage can cause a grinding sensation called crepitus.
  • Patellar Tenderness: The examiner can slightly lift up the kneecap and place direct pressure on the undersurface of the kneecap. By doing so, the examiner is looking for sensitive regions of cartilage.
  • Patellar Apprehension: This is a sign of an unstable kneecap. While the examiner places pressure on the kneecap, the patient may complain of the sensation that the kneecap is going to 'pop out' of its groove.

Sources:

Browne K, Kurtz CA. "How to perform a comprehensive examination of the knee" JAAPA. 2009 Jun;22(6):20-5.

Continue Reading